Deliver or wait with late preterm membrane rupture?

Deliver or wait with late preterm membrane rupture? While ACOG recommends delivery for all women with ruptured membranes after 34 weeks' gestation, a new study finds expectant management may be the way to go. Practice changer: In the absence of clinical indications for delivery, consider expectant management in women with premature rupture of membranes in late preterm stages (34 weeks to 36 weeks, 6 days). Stength of recommendation: B: Based on one well-designed randomized controlled trial: Morris JM, Roberts CL, Bowen JR, et al; PPROMT Collaboration. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet. 2016;387:444-452

On-demand pill protocol protects against HIV

On-demand pill protocol protects against HIV: Finally, there's an effective prevention strategy -- other than condoms -- that can be used, as needed, by patients at high risk for HIV infection. Practice changer: Offer patients at high risk for human immunodeficiency virus (HIV), particularly men who have sex with men, preexposure prophylaxis (PrEP) with a combination pill of tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) on an on-demand basis to decrease HIV-1 infection rates. Stength of recommendation: B: Based on one good quality randomized controlled trial

Easing the discomfort of a speculum exam

Put lubricating gel, not water, on the speculum every time you do a pelvic exam. Stength of recommendation: B: Based on one good-quality, randomized controlled trial (RCT)

This asthma treatment has a lasting side effect in children

Before prescribing inhaled corticosteroids (ICS) for a child with asthma, tell the patient -- and parents -- that their use could lead to a small but permanent effect on adult height. Stength of recommendation: B: Based on one prospective study

Should you consider antibiotics for exacerbations of mild COPD?

Consider antibiotics for patients with exacerbations of mild to moderate chronic obstructive pulmonary disease (COPD)

The shrinking case for saw palmetto

Advise men with benign prostatic hyperplasia (BPH) not to take saw palmetto for urinary symptoms. Explain that it has not been found to alleviate symptoms, even at triple the standard dose. Stength of recommendation: A: Based on evidence from a high-quality randomized controlled trial (RCT)1 and a 2009 meta-analysis

Patient overusing antianxiety meds? Say so (in a letter)

Express your concern about long-term use of benzodiazepines in a letter -- a simple intervention that patients often respond to by reducing or eliminating their use of the drug. Stength of recommendation: A: Based on a well-done meta-analysis with few clinical trials

Let them eat nuts -- this snack is safe for diverticulosis patients

Tell patients with diverticular disease that they can eat nuts, corn, and popcorn without fear. There is no truth to the long-held belief that these foods increase the risk of complications. Strength of recommendatin: B: A large cohort study

SSRIs for depression/heart failure patients? Not so fast

This study should put to rest the practice of starting SSRIs in depressed patients with heart failure in an attempt to affect CVD outcomes. PRACTICE CHANGER: Do not prescribe selective serotonin reuptake inhibitors to improve depression and reduce cardiovascular risk in patients with congestive heart failure. Stength of recommendation: B: Based on one large randomized controlled trial

Acute gout: Oral steroids work as well as NSAIDs

Use a short course of oral steroids (prednisone 30-40mg/d for 5 days) for treatment of acute gout when nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated. Steroids are also a reasonable choice as first-line treatment. Stength of recommendation: B: 2 good-quality, randomized controlled trials (RCTs)